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A AL FEE an RE ORT RE UEST <br />PERMITTEE NAME: Colorado Backhoe Service <br />?' S1 J ntpPERMIT NO.: vNf-2009-074 <br />OPERATION NAME: The Orr Pit r <br />ANNIVERSARY DATE: November 5, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <br />-According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1_16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach Your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous Year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may .suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Thomas Joseph <br />Permittee Name <br />Address <br />Phone Number: <br />Fax Number: <br />Colorado Backhoe Service <br />25193 South Road <br />Pueblo, CO 81006 <br />(719) 924-0288 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />6 tc <br />Date